IMAGE: This is 'Edna' an older adult with chronic low back pain.
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Credit: NIH

An online training module designed for the evaluation and care of chronic pain greatly improved medical student clinical skills, according to a report in the Journal of the American Geriatrics Society. The module, built by the University of Pittsburgh and using an elderly woman with chronic lower back pain as a case study, is the first curriculum resource created through the efforts of the National Institutes of Health Pain Consortium's Centers of Excellence in Pain Education program (CoEPEs). The program was developed in response to the Affordable Care Act's mandate to advance the science, research, care and education of pain.

"Management of chronic lower back pain is one of the most common and difficult problems that patients and health care providers face," said Josephine P. Briggs, M.D., director of the NIH's National Center for Complementary and Alternative Medicine (NCCAM) and member of the NIH Pain Consortium Executive Committee. "The educational materials that have been developed through this partnership will be a great asset in helping the next generation of physicians build clinical skills to support their chronic pain patients."

The CoEPEs were selected in 2012 to act as hubs for the development, evaluation, and distribution of pain management curriculum resources for medical, dental, nursing, and pharmacy schools. The NIH Pain Consortium developed the centers to improve how health care professionals are taught about pain and its treatment. The module is the first to be completed and evaluated for effectiveness.

A team of six experts in education, information technology, pain management, and geriatrics at the University of Pittsburgh developed the module, focusing on common errors in clinical exams, expert modeling, interactivity, and feedback. The module presented a standardized case of an elderly back pain patient called Edna, with brief video clips that showed her interacting with her clinician. The module also contains a multiple choice pre-test, interactive questions, and a multiple choice post-test. Twenty-seven medical students were exposed to the module and 28 were not. The students in the group exposed to the module did significantly better on their objective structured clinical examinations, an exam during which medical students rotate through multiple stations, each with an objective examiner, demonstrating clinical skills and knowledge while interviewing real or simulated patients. Ninety-three percent of the students in the exposed group passed the exam, compared to 60 percent of the non-exposed group. To view the paper (published May 15), go to http://onlinelibrary.wiley.com/doi/10.1111/jgs.12871/abstract.

"To our knowledge, this is the first study that has demonstrated the potential of an online interactive module to improve medical student clinical skills related to evaluating a patient with chronic pain," said the study's lead author Debra K. Weiner, M.D. "While our module focused specifically on an older adult with chronic low back pain, we see this type of educational intervention as a powerful and efficient curriculum tool for a variety of patient scenarios. We look forward to continuing to work with the NIH Pain Consortium in its effort to improve pain care across the country for many different pain conditions that plague patients of all ages."

The CoEPE program is coordinated by the National Institute on Drug Abuse (NIDA), one of 27 Institutes and Centers at the National Institutes of Health. "We are so pleased that the first successful curriculum product created by the CoEPEs relates to solutions for chronic back pain, one of the most common pain conditions in America," said NIDA Director Nora D. Volkow, M.D. "While we know opioids can be powerful clinical allies, a balanced approach that includes a range of pain management options is needed to ensure that people suffering from chronic pain can get the relief they need while minimizing the potential for abuse."

The CoEPEs are creating and testing online, case-based pain education modules for use in their own teaching institutions. Edna and several other modules will be made available to other teaching institutions beginning in the fall of 2014 at http://painconsortium.nih.gov/CoEPEs.html. These modules are also accessible by the general public to help them learn how to discuss chronic pain with their doctors. A preview of the module is available at http://bit.ly/1g3HTo4.

Chronic pain affects approximately 100 million Americans, costing up to $635 billion in medical treatment and lost productivity and contributing to poor quality of life. Yet, pain treatment is not taught extensively in many health professional schools. The curriculum resources developed by the CoEPEs aim to advance the assessment and safe treatment of multiple pain conditions for diverse population groups, while minimizing the abuse of opioid pain relievers. The curriculum resources developed by this program will teach about the various types of chronic pain, medications to treat specific pain conditions, and factors that contribute to both under- and over-prescribing of pain medications. The courses will include the latest research in complementary and integrative pain management.

The sponsors of this Pain Consortium initiative are NIDA: Lead; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Center for Complementary and Alternative Medicine (NCCAM), National Institute of Dental and Craniofacial Research (NIDCR), National Institute of Nursing Research (NINR), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute of Neurological Disorders and Stroke (NINDS), National Institute on Aging (NIA), Office of Behavioral and Social Sciences Research (OBSSR), and the Office of Research on Women's Health (ORWH).

NIH supports the full spectrum of pain research from basic understanding of pain mechanisms through translation of discoveries into treatments and prevention strategies. In FY 2013, NIH supported an estimated $400 million in research focused on chronic pain, not including the related diseases that often cause chronic pain, such as cancer, arthritis, diabetes, and stroke. The details of individual pain-focused grants are publicly available on the NIH RePORTER website. Enhancing education of pain care professionals was highlighted in the June 2011 Institute of Medicine report "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research," a report mandated by the 2010 Patient Protection and Affordable Care Act.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov, which is now compatible with your smartphone, iPad or tablet. To order publications in English or Spanish, call NIDA's DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at http://drugpubs.drugabuse.gov. NIDA's media guide can be found at http://drugabuse.gov/mediaguide/, and its new easy-to-read website can be found at http://www.easyread.drugabuse.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

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